Illuminating the Neuroscience of Decision-making Through the Dark Night of John of the Cross

In this publication, we will use the principal concepts of John of the Cross, the famous mystic of the XVIth century, as a framework to go over, in a non-reductionist way, three challenges in contemporary neuroscience of decision-making. Firstly, the dark night and the purgative paths will be related to discontinuity in decision-making. Secondly, the passive and active paths will be associated to brain plasticity, architecture, and levels of decision. Thirdly, the illumination, which can be felt when a solution is reached, has to do with positive emotions and can be inspired by the science of love of John of the Cross. We shall lastly conclude by emphasizing the usefulness of his work to illuminate the neuroscience of decision-making. 

Spatiotemporal scales and links between electrical neuroimaging modalities

Recordings of brain electrophysiological activity provide the most direct reflect of neural function. Information contained in these signals varies as a function of the spatial scale at which recordings are done: from single cell recording to large scale macroscopic fields, e.g., scalp EEG. Microscopic and macroscopic measurements and models in Neuroscience are often in conflict. Solving this conflict might require the developments of a sort of bio-statistical physics, a framework for relating the microscopic properties of individual cells to the macroscopic or bulk properties of neural circuits. Such a framework can only emerge in Neuroscience from the systematic analysis and modeling of the diverse recording scales from simultaneous measurements. In this article we briefly review the different measurement scales and models in modern neuroscience to try to identify the sources of conflict that might ultimately help to create a unified theory of brain electromagnetic fields. We argue that seen the different recording scales, from the single cell to the large scale fields measured by the scalp electroencephalogram, as derived from a unique physical magnitude—the electric potential that is measured in all cases—might help to conciliate microscopic and macroscopic models of neural function as well as the animal and human neuroscience literatur

Polysomnography in stable COPD under non-invasive ventilation to reduce patient-ventilator asynchrony and morning breathlessness

Background: Stable severe chronic obstructive pulmonary disease (COPD) patients with chronic hypercapnic respiratory failure treated by nocturnal bi-level positive pressure non-invasive ventilation (NIV) may experience severe morning deventilation dyspnea. We hypothesised that in these patients, progressive hyperinflation, resulting from inappropriate ventilator settings, leads to patient-ventilator asynchrony (PVA) with a high rate of unrewarded inspiratory efforts and morning discomfort. Methods: Polysomnography (PSG), diaphragm electromyogram and transcutaneous capnography (PtcCO2) under NIV during two consecutive nights using baseline ventilator settings on the first night, then, during the second night, adjustment of ventilator parameters under PSG with assessment of impact of settings changes on sleep, patient-ventilator synchronisation, morning arterial blood gases and morning dyspnea. Results: Eight patients (61 ± 8years, FEV1 30 ± 8% predicted, residual volume 210 ± 30% predicted) were included. In all patients, pressure support was decreased during setting adjustments, as well as tidal volume, while respiratory rate increased without any deleterious effect on nocturnal PtcCO2 or morning PaCO2. PVA index, initially high (40 ± 30%) during the baseline night, decreased significantly after adjusting ventilator settings (p = 0.0009), as well as subjective perception of PVA leaks, and morning dyspnea while quality of sleep improved. Conclusion: The subgroup of COPD patients treated by home NIV, who present marked deventilation dyspnea and unrewarded efforts may benefit from adjustment of ventilator settings under PSG or polygraph

Distinct locomotor control and awareness in awake sleepwalkers

Sleepwalking is a common parasomnia permitting complex actions to occur outside of consciousness. Kannape et al. show that, also in awake behaviour, sleepwalkers have a different level of conscious awareness when walking under cognitive load, mimicking nocturnal sleepwalking episodes

Actigraphy in Human African Trypanosomiasis as a Tool for Objective Clinical Evaluation and Monitoring: A Pilot Study

The clinical picture of the parasitic disease human African trypanosomiasis (HAT, also called sleeping sickness) is dominated by sleep alterations. We here used actigraphy to evaluate patients affected by the Gambiense form of HAT. Actigraphy is based on the use of battery-run, wrist-worn devices similar to watches, widely used in middle-high income countries for ambulatory monitoring of sleep disturbances. This pilot study was motivated by the fact that the use of polysomnography, which is the gold standard technology for the evaluation of sleep disorders and has greatly contributed to the objective identification of signs of disease in HAT, faces tangible challenges in resource-limited countries where the disease is endemic. We here show that actigraphy provides objective data on the severity of sleep-wake disturbances that characterize HAT. This technique, which does not disturb the patient's routine activities and can be applied at home, could therefore represent an interesting, non-invasive tool for objective HAT clinical assessment and long-term monitoring under field conditions. The use of this method could provide an adjunct marker of HAT severity and for treatment follow-up, or be evaluated in combination with other disease biomarkers in body fluids that are currently under investigation in many laboratories

Patient Machine Interface for the Control of Mechanical Ventilation Devices

The potential of Brain Computer Interfaces (BCIs) to translate brain activity into commands to control external devices during mechanical ventilation (MV) remains largely unexplored. This is surprising since the amount of patients that might benefit from such assistance is considerably larger than the number of patients requiring BCI for motor control. Given the transient nature of MV (i.e., used mainly over night or during acute clinical conditions), precluding the use of invasive methods, and inspired by current research on BCIs, we argue that scalp recorded EEG (electroencephalography) signals can provide a non-invasive direct communication pathway between the brain and the ventilator. In this paper we propose a Patient Ventilator Interface (PVI) to control a ventilator during variable conscious states (i.e., wake, sleep, etc.). After a brief introduction on the neural control of breathing and the clinical conditions requiring the use of MV we discuss the conventional techniques used during MV. The schema of the PVI is presented followed by a description of the neural signals that can be used for the on-line control. To illustrate the full approach, we present data from a healthy subject, where the inspiration and expiration periods during voluntary breathing were discriminated with a 92% accuracy (10-fold cross-validation) from the scalp EEG data. The paper ends with a discussion on the advantages and obstacles that can be forecasted in this novel application of the concept of BCI